ACR/EULAR Boolean Remission Supported as Treatment Target for Early Rheumatoid Arthritis

American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission based on 44 joints should be the preferred treatment target for patients with newly diagnosed rheumatoid arthritis (RA), according to results published in the Annals of the Rheumatic Diseases.

The study included 103 participants with newly diagnosed RA who followed a treat-to-target strategy that incorporated ultrasound information in Aiming for Remission in Rheumatoid Arthritis: a Randomized Clinical Trial Examining the Benefit of Ultrasound in a Clinical Tight Control Regimen (ARCTIC) trial(ClinicalTrials.gov identifier: NCT01205854). The researchers defined 6-month remission according to the Disease Activity Score, Disease Activity Score in 28 joints-erythrocyte sedimentation rate, ACR/EULAR Boolean criteria, simplified Disease Activity Index, Clinical Disease Activity Index, and 2 ultrasound definitions (no power Doppler signal and grey scale score ≤2).

The researchers defined 2 outcomes: no radiographic progression and a combined good outcome of no radiographic progression plus physical function comparable to the general population median, both sustained from 12 to 24 months.

Depending on the definition of remission, 42% to 82% of participants achieved remission at 6 months. In total, 71% of participants had no radiographic progression and 37% had a good outcome.

The researchers found an association between 6-month remission and no radiographic progression ACR/EULAR Boolean remission based on 44 joints (odds ratio [OR], 3.2; 95% CI, 1.2-8.4), ultrasound power Doppler (OR, 3.6; 95% CI, 1.3-10.0), and gray scale remission (OR, 3.2; 95% CI, 1.2-8.0).

They also found that all clinical remission criteria were associated with achievement of a good outcome, whereas no ultrasound remission criteria had this association.

“Our results support current recommendations stating that ACR/EULAR remission including assessment of the feet should be the preferred treatment target in early RA, and that low disease activity is a less preferred target,” the researchers wrote.

Disclosures: The study has received grants from the Norwegian Research Council, the South-East Health Region in Norway, the Norwegian Rheumatism Association, the Norwegian Women’s Public Health Association and unrestricted grant support from AbbVie, Pfizer, MSD, Roche, and UCB.

Please see original article for a full list of author disclosures.

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Reference

Sundlisæter NP, Aga A, Olsen IC, et al. Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes [published online June 22, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2017-212830